|
CLAMP EXTERNAL FIXATION REP B
|
Facility
OP
|
$2,528.50
|
|
| Hospital Charge Code |
64904708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$884.98 |
| Max. Negotiated Rate |
$2,022.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,390.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,264.25
|
| Rate for Payer: Aetna Government |
$1,264.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,022.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,719.38
|
| Rate for Payer: Group Health Inc Commercial |
$1,264.25
|
| Rate for Payer: Group Health Inc Medicare |
$884.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,264.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,264.25
|
|
|
CLAMP GOLD/BLUE
|
Facility
OP
|
$722.50
|
|
| Hospital Charge Code |
40202171
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$252.88 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$397.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$361.25
|
| Rate for Payer: Aetna Government |
$361.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$578.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$491.30
|
| Rate for Payer: Group Health Inc Commercial |
$361.25
|
| Rate for Payer: Group Health Inc Medicare |
$252.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$361.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$361.25
|
|
|
CLAMP LG PIN 6-POSITION
|
Facility
OP
|
$966.00
|
|
| Hospital Charge Code |
40200193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$338.10 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$531.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$483.00
|
| Rate for Payer: Aetna Government |
$483.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$772.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$656.88
|
| Rate for Payer: Group Health Inc Commercial |
$483.00
|
| Rate for Payer: Group Health Inc Medicare |
$338.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.00
|
|
|
CLAMP MR SF 30D OUTRIG POST 11MM
|
Facility
OP
|
$252.00
|
|
| Hospital Charge Code |
40200194
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.00
|
| Rate for Payer: Aetna Government |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$201.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.36
|
| Rate for Payer: Group Health Inc Commercial |
$126.00
|
| Rate for Payer: Group Health Inc Medicare |
$88.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.00
|
|
|
CLAMP MULTI-PIN 6 POSIT MR SAFE
|
Facility
OP
|
$1,402.00
|
|
| Hospital Charge Code |
40200195
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$490.70 |
| Max. Negotiated Rate |
$1,121.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$771.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$701.00
|
| Rate for Payer: Aetna Government |
$701.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,121.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$953.36
|
| Rate for Payer: Group Health Inc Commercial |
$701.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$701.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$701.00
|
|
|
CLAMP PIN/ROD H2 1.5-2/3
|
Facility
OP
|
$1,231.75
|
|
| Hospital Charge Code |
64904428
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$985.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$677.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$615.88
|
| Rate for Payer: Aetna Government |
$615.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$985.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$837.59
|
| Rate for Payer: Group Health Inc Commercial |
$615.88
|
| Rate for Payer: Group Health Inc Medicare |
$431.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$615.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$615.88
|
|
|
CLAMP PIN TO ROD
|
Facility
OP
|
$805.00
|
|
| Hospital Charge Code |
40200632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$442.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.50
|
| Rate for Payer: Aetna Government |
$402.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.40
|
| Rate for Payer: Group Health Inc Commercial |
$402.50
|
| Rate for Payer: Group Health Inc Medicare |
$281.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$402.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$402.50
|
|
|
CLAMP PLASTIC OCCLUDING
|
Facility
OP
|
$1.52
|
|
| Hospital Charge Code |
64901531
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.76
|
| Rate for Payer: Aetna Government |
$0.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.76
|
| Rate for Payer: Group Health Inc Medicare |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.76
|
|
|
CLAMP PORT OUTLET
|
Facility
OP
|
$153.16
|
|
| Hospital Charge Code |
64902223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$122.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76.58
|
| Rate for Payer: Aetna Government |
$76.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$104.15
|
| Rate for Payer: Group Health Inc Commercial |
$76.58
|
| Rate for Payer: Group Health Inc Medicare |
$53.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.58
|
|
|
CLAMP RING
|
Facility
OP
|
$650.00
|
|
| Hospital Charge Code |
40200633
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.00
|
| Rate for Payer: Aetna Government |
$325.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.00
|
| Rate for Payer: Group Health Inc Commercial |
$325.00
|
| Rate for Payer: Group Health Inc Medicare |
$227.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.00
|
|
|
CLAMP ROD TO ROD
|
Facility
OP
|
$892.00
|
|
| Hospital Charge Code |
40200634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$713.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$490.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$446.00
|
| Rate for Payer: Aetna Government |
$446.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$713.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$606.56
|
| Rate for Payer: Group Health Inc Commercial |
$446.00
|
| Rate for Payer: Group Health Inc Medicare |
$312.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.00
|
|
|
CLAMP RT ANGLE
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
40200220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
|
|
CLAMP SCREW HOFFMAN SIDE OPEN
|
Facility
OP
|
$2.29
|
|
| Hospital Charge Code |
64901764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.14
|
| Rate for Payer: Aetna Government |
$1.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
| Rate for Payer: Group Health Inc Commercial |
$1.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.14
|
|
|
CLAMP SINGLE
|
Facility
OP
|
$410.00
|
|
| Hospital Charge Code |
40200635
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$225.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$205.00
|
| Rate for Payer: Aetna Government |
$205.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$328.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$278.80
|
| Rate for Payer: Group Health Inc Commercial |
$205.00
|
| Rate for Payer: Group Health Inc Medicare |
$143.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.00
|
|
|
CLAMP,UMBILICAL CORD,DBL GRIP,ST
|
Facility
OP
|
$2.73
|
|
| Hospital Charge Code |
64903016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.86
|
| Rate for Payer: Group Health Inc Commercial |
$1.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
|
|
CLAMP VASCULAR #37-1071
|
Facility
OP
|
$163.72
|
|
| Hospital Charge Code |
40200443
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$130.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.86
|
| Rate for Payer: Aetna Government |
$81.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$111.33
|
| Rate for Payer: Group Health Inc Commercial |
$81.86
|
| Rate for Payer: Group Health Inc Medicare |
$57.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.86
|
|
|
CLARITHROMYCIN 125 MG/5 ML SUSP
|
Facility
OP
|
$0.76
|
|
| Hospital Charge Code |
41641428
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
CLARITHROMYCIN 125 MG/5 ML SUSP
|
Facility
OP
|
$0.76
|
|
| Hospital Charge Code |
41651428
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
CLARITHROMYCIN 250 MG/5 ML SUSP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41641430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLARITHROMYCIN 250 MG/5 ML SUSP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41651430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLARITHROMYCIN 250 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLARITHROMYCIN 250 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLARITHROMYCIN 500 MG TAB
|
Facility
OP
|
$9.47
|
|
| Hospital Charge Code |
41644216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.74
|
| Rate for Payer: Group Health Inc Medicare |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.16
|
|
|
CLARITHROMYCIN 500 MG TAB
|
Facility
OP
|
$9.47
|
|
| Hospital Charge Code |
41654216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.74
|
| Rate for Payer: Group Health Inc Medicare |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.16
|
|
|
CLD TX CRP/MTCRP DS THMB MN WO AN
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
30306509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
